Medical treatment of renal and perirenal abscesses: CT evaluation.

AIM: A retrospective study of our experience of CT evaluation and follow-up of 16 solitary and multiple renal abscesses treated successfully with antibiotics alone and evaluated with CT at the onset of symptoms and after therapy. MATERIALS AND METHODS: Seven patients had a solitary renal abscess, five had multiple renal abscesses and four had renal and perinephric abscess. None of the abscesses were larger than 5 cm. RESULTS: In all 16 patients, the CT examination showed total renal and extrarenal regression of the abscesses. In four patients, scarring of the renal outline was observed on follow-up. CONCLUSIONS: The study demonstrates the opportunity to avoid aggressive interventional or surgical treatment of renal and perirenal abscesses of 5-cm diameter or less which can completely regress after antibiotic therapy of at least 4 weeks. The CT examination results are important both in the diagnostic phase to establish the extent of the lesions and in the follow-up to check the results of medical treatment.

[Retroperitoneal tumors of nervous origin in adults]. / Tumori retroperitoneale de origine nervoasa ale adultului.

UNLABELLED: Adult's retroperitoneal tumours of nervous origin are infrequent clinical entities with characteristic evolution and treatment. We review 13 cases, dealt with in N. Gh. Lupu Surgical Clinic between 1975-1994 and representing 20% of the retroperitoneal tumour admitted in our clinic during the same period. Most of the patients were males (sex ratio 10:3). The main symptom was the abdominal pain (84.6% of all cases) and all the tumours were extremely big (15-30 cm diameter). The surgical approach always tried to remove the tumour, which succeeded, even if in 4 cases some of the surrounding organs had to be removed also. The two postoperative complications consisted in a severe wound infection and an acute pancreatitis; the second evolved poorly and the patient was lost. No complementary therapy was used. None of the five patients followed up for five years presented clinical evidence of recurrent tumour. CONCLUSIONS: Due to an unexplained evolutive tolerance, adult's retroperitoneal tumours of nervous origin reach large dimensions and have late clinical expression, as the complications occur. Preoperative imagistic findings supply valuable informations for the subsequent surgical treatment. The surgical approach must aim to the ablation of the tumour, with or without the sacrifice of other organs which the tumours can include. This aggressive surgical conduite is sustained by the satisfying postoperative results.

[Pulmonary alveolar microlithiasis--a clinical case]. / Microlitiaza alveolara pulmonara--caz clinic.

A new case of alveolar microlithiasis is reported, demanding for the diagnosis besides the radio-clinical investigations, complete respiratory function tests, also the pathologic proof. Authors recall the diagnostic approach and our present ignorance of the pathogenesis of this curious entity; no valid therapy is presently able to check the relentless course toward progressive respiratory failure.

[Clinical study of the efficacy of albendazole treatment in human hydatidosis]. / Studiu clinic al eficientei tratamentului cu albendazol în hidatidoza umana.

A follow-up study of Albendazol effectiveness therapy in human hydatid diseases was carry out using WHO methodology. Albendazole was given at a dose of 10 mg/Kg body/day in cycles of 28 days separated by 14 days without treatment. The efficacy of chemotherapy was evaluated by clinical improvement and changes in the cyst's morphology (detachment and collapse of the cyst membrane and increased density of the cyst fluid). We performed this study in 134 patients with hydatidosis: 17 patients with pre and post surgery treatment, 50 patients with post surgery treatment and 67 patients with chemotherapy only. Albendazole was effective in the hydatid disease; the patients with complex chemotherapy treatment did not report any secondary hydatidosis during the follow-up period (max. 2 years); the patients with exclusive chemotherapy reported 79% successful response, only 21% of them remained with unchanged cyst's size, but with modified internal structure. The therapeutic response depends of the cyst's size and its visceral site.

[Computed tomography in establishing the therapeutic management of lung cancer]. / Contributia tomografiei computerizate în stabilirea conduitei terapeutice a cancerului pulmonar.

Computer tomography (CT), a noninvasive method of high complexity, compelled recognition in pneumological practice, becoming indispensable. The present study deals with 59 patients suspected of bronchopulmonary cancer, who were submitted to computer tomography, besides other examinations. CT contribution in establishing the diagnosis, the therapeutical line (particularly in determining the surgery moment) as well as the correlations (concordance and discordance) between the information offered by CT and by other conventional (radiological, bronchological) methods are analysed. The association of thin needle trans-thoracic biopsy (TNB) to CT ensures an important histologic confirmation which amounts to 75% of investigated cases, according to our statistical data.

The value of computed tomography in the diagnosis of the prehepatic portal hypertension.

The dynamic computed tomography (CT) is used by the authors in a complex system of investigations. It is preceded by a diagnosis stage which determines the "normal" character of the liver and it is followed by the angiographic exploration for the cases with surgical indication. 36 patients with CT diagnosis of prehepatic portal hypertension were studied; from these patients, 24 had an angiographic confirmation and 16 of them were operated. The most valuable CT signs which have been found by the authors were: the study of the portal vein at the hilum level and in the distal parapancreatic region, the hypoplasia of the left hepatic lobe and the absence of the ascites. The other signs were considered less important, only the localization of the porto-systemic shunts being to a certain degree important for surgery. It is underlined the early age of the patients (69% are under 30 years old). The diagnosis concordance was in the studied group 100% for the positive diagnosis of the syndrome, but only 79% for the localization of the obstruction. CT is the most innocuous diagnostic procedure which obtains a maximum of data on the portal system morphology.

Saddle block with pethidine for perineal operations.

Saddle blockade with pethidine hydrochloride was performed in 111 patients undergoing short surgical operations on the perineum. A dose of 5% pethidine 0.5 mg kg-1 was injected to the subarachnoid space at L4-5 or L5-S1 with the patient in the sitting position. Sensory blockade was achieved in 5.28 +/- 1.43 min. This extended to the sacrococcygeal area, perineum, buttocks and posterior surface of thighs, and was followed 1-2 min later by motor blockade. During the operation the patients were stable haemodynamically and no respiratory depression was recorded. Sensory blockade lasted for 141 +/- 26.06 min and was followed by postoperative analgesia, the mean duration of which was 301 +/- 98.38 min. Postoperative neurological complications were recorded in three patients (2.7%): headache alone in one, headache associated with backache in one, and leg weakness, backache, nuchal rigidity and photophobia in another. Seven patients (6.3%) complained of itching, five patients (4.5%) of nausea and vomiting and two (1.8%) developed urinary retention.